Terena S Stidham, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-081469 Issued in AL

Practice address

65345 Hwy 17
Detroit, AL 35552

Phone

(205) 273-4056

Fax

(205) 273-4058

NPI assigned

May 12, 2006

Last updated

Sep 24, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Watson Family Clinic

  • Family Nurse Practitioner
  • Hamilton, AL
  • NPI 1871488072
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348444800000",
    "number": "1861443087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MAIN ST N",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388213416",
            "telephone_number": "662-256-7112",
            "fax_number": "662-256-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65345 HWY 17",
            "city": "DETROIT",
            "state": "AL",
            "postal_code": "35552",
            "telephone_number": "205-273-4056",
            "fax_number": "205-273-4058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "TERENA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2012-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R857697",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-081469",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "2005009897-22",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl Andrew Ballard, FNP-C
• Nikki Malensky
• NWMC-Winfield Physician Practices, LLC

• Family Nurse Practitioner in Detroit, AL
• Providers in Detroit, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.